Cardiology is a Team Sport

In patient care, we all know the best outcomes come with teamwork. A team approach achieves the best care by drawing upon the unique strength of each member to form the ultimate authority or “single voice of action.” Recently I had an 84 year-old patient with Hypertrophic Cardiomyopathy (HCM) who suffered cardiogenic syncope while driving. I made a tough decision to have my colleague implant an ICD for secondary prevention. Unfortunately, she developed pericardial tamponade, requiring echocardiography, pericardiocentesis, and surgical intervention the next morning for ongoing bleeding. She eventually left the hospital, thanks to the heroic teamwork of non-invasive cardiologist, interventional cardiologist, electrophysiologist and cardiothoracic surgeon. The situation highlighted something that I’ve been increasingly troubled with: the professional fragmentation of our cardiovascular community, and its effects on invasive cardiology. Specifically, why is it that we know we must work together for patient care, as in the above case, but increasingly insist on separating ourselves professionally? We exist professionally in silos. There are separate conferences for electrophysiology, interventional cardiology, cardiothoracic surgery, echocardiography and nuclear cardiology, and recently also separate journals for each. Invasive cardiologists, both EP and Interventional, were the first to leave, and perhaps therefore have ourselves to blame. Now, I understand how this all came about. People want conferences and journals tailored to their practice. And, in their defense, the sub-subspecialty conferences and journals have remained top-notch, breaking the rules and setting new standards. I also understand that conferences are “big money” for the sub-subspecialty societies, as new journals are “big money” for their publishers. On first glance, therefore, it’s a “win-win” all around. Yet, there is significant fall-out from this fragmentation. Less invasive cardiology attendance at the major meetings (ACC and AHA) means less opportunity for the necessary mingling that binds our cardiovascular community together. In addition, we as invasive cardiologists are rapidly losing our more general knowledge-base and perspective as we dive into our individual niches. For right or wrong, we have lost credibility within the larger cardiovascular community. Fragmentation breeds misunderstanding at best and distrust at worst. It is not simply a coincidence that invasive (both EP and Interventional) and non-invasive cardiologists have become increasingly antagonistic towards one another. Non-invasive cardiologists feel invasive cardiologists are doing too many unnecessary tests and procedures, while invasive cardiologists feel the non-invasive folk are out of touch with technology and its role in patient care. Neither feels the other has kept up on their literature, and both start to lose faith in the other’s ability to prioritize patient care over individual interests. Not surprising, therefore, that we fight amongst ourselves over trials or technologies that pit one sub-subspecialty against another, and fear that we as invasive cardiologists are not fairly represented by our parent societies. The fallout is also political. Despite its best efforts, the ACC did not have the weight of the entire cardiology community behind it when it pushed to challenge the Medicare cuts, or even in terms of health care reform debate. We have made ourselves powerless by cutting off all our appendages. In effect, we have lost our “single voice of action” as a cardiovascular community, and it’s become painfully evident. So, read your individual sub-subspecialty journal, but also read the parent journal. And go to your sub-subspecialty conference, but also attend the parent conference from time to time. Get involved in the ACC or AHA at the local, regional or national level and convince them that invasive cardiologists are cardiologists first, invasive second. In short, be a team-player professionally as well as clinically. Show them that cardiology always works best as a team sport. Dr. Srihari S. Naidu is Director of the Cardiac Catheterization Laboratory, Interventional Cardiology Fellowship Program and Hypertrophic Cardiomyopathy Center at Winthrop University Hospital on Long Island, and Assistant Professor of Medicine at SUNY – Stony Brook School of Medicine.